The OIG continues to recommend that CMS increase the frequency of hospice recertification surveys. On August 29, 2013 the OIG published a new hospice report (OEI-06-13-00130) entitled the Frequency of Medicare Certification Surveys is Unimproved. This report is a follow-up to the OIG's April 2007 report (OEI 06-05-00260) Medicare Hospices: Certification and Centers for Medicare and Medicaid Oversightthat recommended CMS seek statutory or regulatory timeframes to increase the frequency of hospice surveys, suggesting three years as an appropriate timeframe. CMS did not concur with that recommendation since conducting more surveys would require unlikely Congressional action to allocate more resources.

The OIG conducted this new study to determine if there has been any improvement in the frequency of hospice recertification surveys. The OIG analyzed national survey data from 2011 on 2,483 hospices to compare survey frequency to the previous findings in the 2007 report. Their most significant findings include:

17% of State-surveyed hospices (416 of 2,483) had not received a recertification survey in 6 years or longer;

The length of time since the most recent survey date for these hospices ranged from 8.4 years to an astounding 22 years;

In 12 States, more than 25% of the hospices had not been recertified in the previous 6 years.

These findings lead the OIG to conclude that the frequency of hospice recertification surveys has not improved since 2005 and the OIG is concerned that CMS and State survey agencies may not be able to adequately ensure hospice compliance with the Medicare Conditions of Participation.

The OIG reiterated its previous recommendation that CMS set specific timeframes through legislation or regulations regarding the frequency of hospice recertification. Similar to the regulatory requirements for nursing facilities to be recertified every 15 months and home health agencies every 36 months, the OIG suggests CMS consider a timeframe of every 3 years, consistent with the timeframe for hospice re-accreditation surveys.

Although the OIG is hopeful that the new hospice quality reporting requirements may assuage some concerns regarding the quality of care provided by hospices, data will not be available for a number of years to assist with informing the hospice survey process.

What does this report mean for hospices? Nothing immediately. Perhaps there will be a regulatory change at some (probably distant) future date establishing timeframes for hospice surveys.

More immediately, hospices may be so burdened with payment-related scrutiny from the various Medicare and Medicaid contractors that compliance efforts with the Medicare Conditions of Participation (which are related to patient safety and quality of care rather than payment) may lapse. Given the increasing overlap in payment-related scrutiny and the Medicare Conditions of Participation, hospices need to be certain to monitor compliance with both.